Concealed Carry for EMS: 2 Questions

Concealed carry for paramedics and EMTs has been a hot topic in the EMS blogosphere recently. Other bloggers have already waxed poetically and philosophically on the topic. For some of the best see Ambulance Driver and EduMedic. There was also this article about EMTs that want to carry guns on the job.

I understand the absolutist argument that concealed carry should not be limited in any structure, vehicle, or open area. The momentum on the issue of no limits on concealed carry is strong. Any political capital an opponent of concealed carry might have is probably better spent on other issues.

Thus my two questions about concealed carry in the EMS workplace which includes but is not limited to stations, EMS vehicles, patient vehicles and homes, hospitals, pharmacies, nursing homes, public places and roadways, private business, day care facilities, taverns, etc. are:

Why is concealed carry preferable to open carry?

Intuitively I think a visible firearm is a better deterrent, easier to access, and quicker to access than a concealed weapon. What am I missing? Why aren’t we arguing and advocating for open carry in the EMS workplace?

Which patient would you have shot?

Many apparatus bay and training room conversations start with “If only I would have had … I could have … ”

If only I would have had intranasal narcan I could have …

If only I would have had serial 12 leads I could have …

If only I would have had a King LT I could have …

If only I would have had haldol I could have …

If only I would have stepped left I could have missed the patient’s left handed haymaker …

Do you have a “If only I had a concealed weapon I would have shot that patient“?

At my core I am a realist. Concealed carry is coming to the EMS workplace. Doesn’t really matter if I believe it should or should not. If we want to add a tool to our arsenal we should be able to look back at previous incidents and identify times we could have used that tool. Use those incidents to equip and train for same or similar incidents in the future.

That’s only one among many thousands of calls in my career, but it only takes one. This call was just the kind that you can’t foresee that goes pear-shaped very quickly,

As it was, violence was averted by the timely arrival of the police and a Taser, but for a few minutes there the possibility of caving someone’s skull in with a D cylinder was something altogether more real than joking about it in a squad bay. The guy meant to kill me or hurt me badly, and I was equally determined to kill him if that’s what it took for me to go home un-maimed.

Would I have shot him if I’d been carrying a firearm?

Off-duty, definitely. And I wouldn’t have any doubt I had made the right decision.

On-duty, I just don’t know. I had improvised defensive weapons available, the police were seconds away… I just don’t know. I like to think that I’d have stopped with braining him with the oxygen cylinder, and that I’d have only pulled my weapon if he’d had one. I’m glad I never had to find out.

What I DO know is, if the police had been even 30 seconds farther away, he’d be dead or maimed, or I would be. And I did everything right on that call. There was no reason to suspect a dangerous scene. THOSE are the kinds of calls that kill you, the ones where CCW might mean the difference.

On the subject of open carry, I think the deterrent factor is overstated, as is the risk of being singled out by an attacker, and open carry DOES make weapons retention more of an issue. Even cops have their guns taken away from them, and people shoot at cops, too. If someone is going to use a gun to inflict his will upon you, you have to presume he’s willing to use it whether he knows you’re carrying a weapon or not.

There is a mental and emotional hurdle to overcome in shifting from the focus of saving a life to being willing to take one, and any sane human being would be wise to consider it. Without the mental preparation to kill someone, carrying a weapon is useless. The firearm is a tool. The WEAPON is the attitude.

And that’s just the problems with carrying a weapon only *I* know about. I’m not ready for my patients to see me as a potential adversary. I like being seen as the good guy by the vast majority of my patients, and openly carrying a weapon negates your ability to position yourself as a non-combatant.

It’s a thorny issue, and I hope it doesn’t become a widespread practice in EMS. But I’m not going to deny that option for another person if it’s a legal option for them.

http://everydayemstips.com Greg Friese

AD, thanks for sharing your experience. We are all glad you survived the encounter with the violent/hostile patient.

I admire and appreciate your introspection on the topic. Since there is little time/friction in the process of acquiring a weapon and permit it becomes incumbent upon the permit holder and carrier to do the mental preparation, as you suggest, as well as the kinetic preparation (drawing, aiming, and firing practice).

With firearms, as well as many other things, more forethought, planning, and thinking through different scenarios is beneficial to the individual and the community.

Stay safe!

Ambulance_Driver

I would submit that anyone who has taken the time, money and training to meet the legal requirements to carry a concealed handgun is already well on the way in terms of mental preparation, although I will agree that some states’ classes should be longer.
It’s just that the form of mental preparation needed runs counter to the mindset of the typical EMS provider.

EduMedic

This topic has sucked us all in, hasn’t it? My main reason for blogging on the topic was to see how labor & management can find common ground to begin discussions. I had some interesting responses. I’m looking forward to seeing the responses your readers offer up to your questions, Greg.

As for me, I’ve never had an, “If only I would have had my 9mm,” moment. I consider myself lucky, too. Many, many others have been put in those loathsome situations.

I’m with Kelly on the open carry question. Weapon retention is a huge price to pay for the relatively low (according to my LEO friends) deterrent benefit.

http://everydayemstips.com Greg Friese

Thanks EduMedic for sharing your experience and knowledge on the topic.
Like you I have never had a “9mm moment” but not having one is more than just luck. It is a complex combination of system design, population served, dispatching, your experience, partner’s experience, and more. I am fond of the goaltender saying “It is lucky to be good and good to be lucky.”

Stay Safe!

http://everydayemstips.com Greg Friese

Jimmy, thanks for joining the conversation.

Going from “potential violence is the last thing on your mind” to accessing, drawing and aiming a weapon is something I wonder about. It likely requires excellent recognition/perception of danger accompanied by an almost instant decision at the same moment as a very rapid, smooth, and coordinated movement and could happen while in many different positions (sitting on bench seat, kneeling next to patient, sitting on captain’s chair, etc.) This would require lots of repetition practice. Also complicated by likelihood the paramedic might also be holding something like a laptop, IV catheter, etc. Would accessing a weapon of opportunity in close quarters, like the laptop or oxygen bottle, be a better defensive strategy?

Q: Why is concealed carry preferable to open carry?
A: I think open carry does make you a bigger target, reduces your credibility in the eyes of the patient (unless you are clearly identified as a dual or tri-role public safety officer), and it can become a point of morbid fixation in interacting with others (as in, “wow, a gun, have you ever had to use it”, or, “wow, a gun, I bet I could take it from him/her”). Concealed is a better choice to maintain our appearance to the public as non-authoritative, compassionate caregivers. All that said, I don’t believe anyone lawfully carries concealed because they are expecting to use it. If you were expecting to use it, wouldn’t you have brought your shotgun and a SWAT team with you? If you were expecting to use it, that could also cross the line from lawful to criminal, since its use is now premeditated.
Q: Which patient would you have shot?
A: Thankfully, none, and I never would have drawn it either, but there have been many hairy situations where I would have liked a better fallback plan, and as AD said, I did everything right and things still didn’t go as planned. I had a violent dog guarding a victim/patient and she charged me, but an O2 bottle to the side of her head changed her mind from trying again. Dog was dazed but okay, until she was put down by animal control anyway. My martial arts training has paid off far too many times though. Weapons retention would never have been a concern if I were carrying concealed, as there wouldn’t have been time.
Q: Bonus question: should the employer provide employees smartphones handguns or is BYOD BYOW preferable?
A: BYOW should be acceptable. You train with your own weapon, so placing a standardized, department issued one in your hands will not be as comfortable, and again, concealed works different for everyone, depending on placement, hand size, caliber comfort. It also plays against muscle memory. If the employer wants to provide, then they shold be ready to provide several thousand rounds per year for practice for me to be comfortable with it and accept all liability related to its use and carry. If you want to stem liability for BYOW, all that should be required is something like a gunsmith certification of functionality and safety. Or better yet, it’s concealed anyway, so why should the employer be involved if you aren’t on their tactical team? Carry your own liability insurance, and every employee signs a waiver of liability for the employer, whether they carry or not, so it remains anonymous as possible. Don’t ask, don’t tell should be the mantra. Otherwise, I guess it really isn’t concealed after all.
I’m going to plug a graphic I just created on “Assault Shakers”. You can drop by my blog to see the post. What’s the difference between the two salt shakers? There isn’t any difference. It’s how they are perceived and how they are used. Both can contribute to your death and discomfort; both can be used to make you feel better about your interaction with their targets. As AD said, it’s the attitude that makes the difference.
Incidentally, I’ve never carried a salt shaker or an assault shaker on the job either. The salt I adminster is carefully measured and prescribed in the bags of 0.9% NS Solution.

http://everydayemstips.com Greg Friese

Thanks for joining the discussion.

You also touch on the same issue that Dan mentioned – the training to maintain competency. “Several thousand rounds per year.” I am guessing their are many concealed carry people that shoot tens of thousands per yes, some that shoot several thousand per year, some that shoot a few hundred, and some that shoot none. Should the employer expect the holder to maintain some sort of competency through practice and testing?

Stay safe.

http://twitter.com/unwiredmedic Christopher Matthews

Q: Should the employer expect the holder to maintain some sort of competency through practice and testing?
A: Only if they are issuing the firearm or condoning the carry. If they are simply “not prohibiting” it, they should have no say, a.k.a. “laissez faire”. I don’t have to prove any more competency to maintain my CCW permit. I just pay renewal fees and do a background check. That’s me walking around as a civilian, off the clock. Any training I do is of my own volition. I have to be comfortable with my competency. To me, that means sending several thousand rounds per year downrange. It’s expensive. We train in EMS to muscle memory (how to board, how to start an IV, how to run a code, etc.), so repetition is essential to solidifying our competence. As has been said, the firearm is a tool. You must train to use it, but if there isn’t an implied or implicit endorsement on the agency’s part, they can’t set mandates. They don’t regulate our phones, stethoscopes, wristwatches, or pens. Primarily because they don’t provide them. If they mandate it, the burden of provision falls to them (uniforms, ALS equipment, radios, PPE, etc.).

I’m surprised no one has brought up red or green targeting lasers yet. Should that be mandatory if you are to carry at work? Proven to increase targeting accuracy, especially under duress.

http://www.facebook.com/profile.php?id=1088829873 Skip Kirkwood

I disagree. The employer is liable for everything that goes on with that crew while on duty, whether they choose to use a relaxed approach or not – they call it “respondeat superior,” and until some high court ays otherwise, that’s the state of the law in the U.S. for the last hundred years or so. Therefore, the employer has the right to impose conditions. The “may” not regulate your phones, wristwatches, or pens, but they certainly have the right to do so.

My concern is that moving this discussion to firearms right away is like saying that we’re going to use surgical airways on everyone, and bypass nasal oxygen, oral airways, nasal airways, King airways, ET tubes, and CPAP. Less than 1% of people with ventilation problems need a surgical airway, and less than 1% of threatening situations involve the possibility of a deadly force encounter. It is inherently unreasonable (“negligent”) to prepare yourself for a very unlikely encounter, while ignoring the very real threats that are faced every day.

I’m all for comprehensive pre-service and in-service violence deterrence and management program that includes PROFICIENCY in all the skills from verbal de-escalation through soft and hard intermediate techiniques, but until then – no deadly force.

http://everydayemstips.com Greg Friese

Chief, thanks for joining the conversation. I concur on both the liability of the employer as well as the employer right to regulate the workplace. Anecdote – I had an employer that insisted/mandated paper PCR’s be written with black ball point pen. Any other color was strictly taboo and grounds for discipline.

I think policy makers and public opinion are moving faster than employer’s conversations and implementation of policy regarding concealed carry as well as violence deterrence and management.

Stay Safe.

http://twitter.com/unwiredmedic Christopher Matthews

@facebook-1088829873:disqus – “Respondeat superior”, a cool term, and thanks for sharing something I’d never heard of, but upon my review, I learned it isn’t actually law. It’s doctrine and applicable to civil litigation, as no laws would be broken by lawful exercise of the 2nd Amendment, (note the key word “lawful”) and in accordance with state and local regulation. You do bring up good points and I don’t disagree with all of them. But I don’t agree with all of them either.
I’ll add to your <1% comment. How many calls do we use activated charcoal, sodium bicarbonate, or calcium on? How many surgical airways do we perform per year? How about obstetrical kits for imminent field delivery? How about needle decompression? How about traction splints? Chemical sedation? Opioid pain management? I don't have handy statistics, since we don't have a national database to query, so I'll have to resort to anecdotal evidence. I'd venture to say less than 1%?
For my own example, in a metropolitan EMS system, I ran roughly 6,000 calls in 3 years, and I can say I used a needle to decompress a chest twice, chemically restrained four times, given pain medications about 3 dozen times, needle crich'ed (but not surgical airway'ed) once, and applied two traction splints. I'd even venture to say that it was less than 1% combined. Of course some areas will see more use than others, and others will have less or even 0% usage, but aggregate numbers? So by using your previously mentioned reasoning, it is inherently unreasonable to prepare ourselves for such very unlikely encounters? Why bother stocking these supplies or training for these procedures with such a rare frequency? We should focus on basic life support only, since that is where the meat and potatoes are and we can qualify the efficacy.
Is it liability that motivates our agencies? Because it certainly isn't cost effective to invest so much energy and funds on the procedures and supplies given the rate of return. I'd venture to say something equally egregious: 99% of what we do (as a profession, not individually) is to avoid the 1% that yields legal ramifications, especially since we can't prove that most ALS makes a statistical difference in the outcomes of our patients, but it does make people feel good about us. Show me a single agency that says, "Morphine and heated blankets for everyone, because we want people to feel good about using our service!" Rather you'll hear that you shouldn't be using supplies that aren't needed, because it is expensive and Medicare doesn't pay for any of them anyway. We're taught to document for legal defensibility first and reimbursement second. Liability first, right? Our liability increases with the amount of procedures we are eligible to perform relative to the lesser frequency with which we train or use them. Hence, we are mandated to invest hundreds of hours in our career for advanced airways, and scarcely a handful of hours on psychology, sociology, and crisis intervention. But we do it anyway.
For every day of my life I've had access to a firearm, I've drawn it once, on a dog chasing down my kids of all things, and fired it in defense zero times. That's less than 1%, ergo I should not have a firearm since it is used so infrequently? Do you think that it would have been a different outcome for the National Guardsmen having breakfast at IHOP in Carson City, or the theater patrons of Aurora, or the Sikh temple victims, or the victims at the Congresswoman Giffords shooting, or the VA Tech campus shooting, or…, or…, or… (name your public shooting) had someone at each of those incidents been lawfully armed? I bet people would have still died at each of the incidents, but maybe a few less. Less families may have to mourn their dead and wounded. There are no guarantees, so I may not win the fight myself by virtue of being armed, but at least I increased my chance at not having my family mourn the loss of me. The perpetrator doesn't hold to our ideals or they wouldn't be there in the first place. That line of reasoning goes out the window when dealing with extreme psychosis or sociopathy. We should be better equipped to train our people more on driving the ambulance safely, since that is where the bulk of our injuries and deaths occur. That, factually, presents a far greater liability (realized, not perceived) to us than the perceived liability of rapid access to firearms or denial of Constitutional rights. If we do this stuff for the rare, but expensive liability risk, I say my life, and my partner's life is worth more than any settlement or court award. Martyrs don't put food on the table and raise your children and grandchildren. They don't provide retirement with your mate. You simply cannot put a price on that liability.
I agree totally with the deterrence and management program. I see tremendous value in it, and I've used it on the job numerous times, just to get away from an aggressor. I've invested hundreds of hours in de-escalation techniques and assaultive behavior intervention, and I teach my students the same. I also instituted an unarmed assaultive behavior intervention program at the college EMS program I teach at. I've also studied martial arts for many years. I also advocate issuing ballistics vests with trauma plates, because karate's neat, but not from 30 feet. I've also needed that protection less than 1%, but the one time I do need it and don't have it, that will be the day my wife files for the PSOB.
A couple recent comments, here and abroad, have prompted me to draft another blog article. Please drop by The Unwired Medic soon and chime in. I am thoroughly thrilled with this discussion. I need to hear both sides. I have to then weigh what I feel is more important, and not accept an emotionally charged position. I don't want to force my beliefs on anyone else, nor will I ever accept vice versa. It should be weighed by every agency, and every employee (citizen). The decisions should be as educated as our highly acclaimed "informed consent" is supposed to be.

http://everydayemstips.com Greg Friese

Chris you also need to be open to the possibility that more people may have died or been injured in the cross fire between the shooter and armed citizens attempting to neutralize the shooter.

http://twitter.com/unwiredmedic Christopher Matthews

Sorry @facebook-1088829873:disqus – You said, “state of the law” and I misread that as law, and you’re right, and yes, as I mentioned they may regulate, but then they have to provide it or reimburse for it, or we can write it off as a tax exemption.

Too Old To Work

I have a few thoughts that might be a bit different, not that that will surprise you.

Open carry can be problematic at least from a perception standpoint. That’s in addition to what other commenters have said.

Carry a firearm is a personal decision, and it’s not just related to EMS. I guess I’m an absolutist because I think anyone that is qualified by law to own a firearm should be able to carry it whenever they feel the need. There are some exceptions, but they apply to everyone.

Do we go into dangerous places? Yes, but so do a lot of other people. On the other hand, it’s generally not the patient that poses a risk. We are not immune to being robbed or attacked while at work for reasons not having anything to do with work.

There is no reason that our job should require us to forfeit, even temporarily our right to self protection.

http://everydayemstips.com Greg Friese

Thanks for joining the discussion.

We also are not immune to violence in the workplace from our co-workers, estranged spouses or significant others, and disgruntled customers.

Self protection is a continuum of behaviors from retreat to standing our ground. Does it need to necessarily extend to concealed carry?

Stay safe.

http://everydayemstips.com Greg Friese

Thanks Dan. I appreciate your perspective as both a police officer and a paramedic.

Do you think the broad nature of concealed carry legislation will force employers to allow or to at least not prevent employees from concealed carry?

I agree with most of the comments here. My main concern is that a provider meet certain qualifications if they want to carry. Just like any other skill we perform on the truck! So if a medic wants to carry there should be a standard higher than just being able to afford a firearm. That’s all. I really don’t have any scary stories, but it’s really only a matter of time Imo.

http://everydayemstips.com Greg Friese

Daniel,

Thanks for joining the conversation. A qualification standard for carrying on the job would be an interesting addition and the expense, either borne by the employer or the individual, might make the whole process unaffordable.

I am with you that I think it is inevitable that there will be no limits on concealed carry.

I have a theory, don’t carry anything you don’t want someone
to take away and use on you, this goes back to the 80s when and 90s when some
of my co-workers felt they need to carry a 22 D-cell Mag-lights. Well one day I
was requested to assist a medic that was having an altercation with a patient,
upon my arrival there was my medic being choked by the patient with his
mag-light. Back in the day 70s there were no rules and I did carry (hidden) at
both my volunteer company and my paid job. I don’t miss carrying a gun and even
if it were permitted doubt I would. As far as needing a gun I have a theory there too, if the situation gets that bad Godgave me two legs so feet don’t fail me now! Now I work in a pretty uneventful crime area so a gun really isn’t nessasary.